Different Inspiratory Flow Waveform during Volume-Controlled Ventilation in ARDS Patients

The most used types of mechanical ventilation are volume- and pressure-controlled ventilation, respectively characterized by a square and a decelerating flow waveform. Nowadays, the clinical utility of different inspiratory flow waveforms remains unclear. The aim of this study was to assess the effects of four different inspiratory flow waveforms in ARDS patients. Twenty-eight ARDS patients (PaO₂/FiO₂ 182 ± 40 and PEEP 11.3 ± 2.5 cmH₂O) were ventilated in volume-controlled ventilation with four inspiratory flow waveforms: square (SQ), decelerating (DE), sinusoidal (SIN), and trunk descending (TDE). After 30 min in each condition, partitioned respiratory mechanics and gas exchange were collected. The inspiratory peak flow was higher in the DE waveform compared to the other three waveforms, and in SIN compared to the SQ and TDE waveforms, respectively. The mean inspiratory flow was higher in the DE and SIN waveforms compared with TDE and SQ. The inspiratory peak pressure was higher in the SIN and SQ compared to the TDE waveform. Partitioned elastance was similar in the four groups; mechanical power was lower in the TDE waveform, while PaCO₂ in DE. No major effect on oxygenation was found. The explored flow waveforms did not provide relevant changes in oxygenation and respiratory mechanics.